RELEVANCE TO PUBLIC HEALTH Manual wheelchair users are at considerable risk of developing upper limb overuse injuries. One preventative measure is to improve the user's push style. This project will develop the understanding required to teach proper propulsion technique. ABSTRACT Manual wheelchair propulsion is the primary mode of locomotion for millions of people around the world. Manual wheelchair users rely on their upper extremities (UE) for mobility. Pain and injury in the UE can severely impact mobility, independence and quality of life. Unfortunately, UE pain and injury is very common among manual wheelchair users. How someone pushes his wheelchair is likely related to the development of UE injuries. Despite the importance of propulsion technique, we do not know how to optimally propel a wheelchair. The reason for the lack of information is primarily due to a lack of research. The proposed project will address the need for fundamental research in wheelchair propulsion technique. The project will involve: 1) developing the instrumentation and methods required to provide real-time individually tailored propulsion technique biofeedback, 2) developing a musculoskeletal propulsion model and using it to predict the consequences of technique changes, 3) measuring the biomechanical and metabolic effects of providing biofeedback for a population of wheelchair users and 4) assessing the efficacy of repeated training sessions using an optimal biofeedback strategy. This research will fill in the gaps in our understanding, develop innovative approaches to improving technique and will demonstrate that improving propulsion technique can reduce demand on the wheelchair user. Implementation of the knowledge gained from this research is hoped to contribute to the reduction of upper extremity injuries in the wheelchair user population.